IRC SECTION 125 CHANGE-IN-STATUS EVENT MATRIX

To enroll dependent(s) in health benefits, you must submit the following EMACS forms (within 60 days of event): • Premium Deduction Election Form • Medical Expense Reimbursement (FSA) Plan Enrollment Form or Medical/Dental/Vision Plan Enrollment-Change Form • judgment, decree or order • birth certificate(s) Gain of coverage through ................
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